CASE REPORT

Post-traumatic renal artery thrombosis secondary to blunt abdominal trauma: a rare case report

Harry Galuh Nugraha , Eppy Buchori Aristiady, Hilman Hilman, Dian Komala Dewi, Leni Santiana, Puspita Arum

Harry Galuh Nugraha
Medical doctor, Faculty of Medicine - Universitas Padjadjaran, Bandung, Indonesia. Email: hg.nugraha@gmail.com

Eppy Buchori Aristiady
Medical doctor, Faculty of Medicine - Universitas Padjadjaran, Bandung, Indonesia

Hilman Hilman
Medical doctor, Faculty of Medicine - Universitas Padjadjaran, Bandung, Indonesia

Dian Komala Dewi
Medical doctor, Faculty of Medicine - Universitas Padjadjaran, Bandung, Indonesia

Leni Santiana
Medical doctor, Faculty of Medicine - Universitas Padjadjaran, Bandung, Indonesia

Puspita Arum
Resident Radiology, Faculty of Medicine - Universitas Padjadjaran, Bandung, Indonesia
Online First: July 09, 2021 | Cite this Article
Nugraha, H., Aristiady, E., Hilman, H., Dewi, D., Santiana, L., Arum, P. 2021. Post-traumatic renal artery thrombosis secondary to blunt abdominal trauma: a rare case report. Bali Medical Journal 10(2): 587-590. DOI:10.15562/bmj.v10i2.2319


Background: Blunt abdominal trauma is one of the leading causes of morbidity and mortality among populations worldwide. However, renal artery injury due to blunt abdominal trauma is a rare occurrence. In this case, a patient who suffered multiple trauma was found in the emergency department, including blunt abdominal trauma, after a motor vehicle accident.

Case report: A 13-year-old boy with multiple trauma was referred to our emergency department, with the primary consideration being to lose consciousness 3 hours before admission due to a traffic accident. After receiving examination, there was no evidence of abdominal bruising, whereas the results of the head CT scan show epidural hemorrhage. After four days of treatment, the urea and creatinine serum levels increased, abdominal CT scan shows right renal infarction suggestive of right renal arterial rupture. The patient was diagnosed with a moderate head injury and right renal trauma AAST grade IV. The patient was referred to the interventional radiology unit. The endovascular revascularization techniques were performed with renal artery stent placement and vasodilator (nitroglycerin) flush into the renal artery before stent placement. Renal artery stenting placement performed on main right renal artery demonstrates the absence of intraluminal defects and substantially blood flow was established, abdomen CT Scan shows an enhancement on right renal parenchyma which mean right kidney vascularization appears to be improved with the return of glomerular filtration rate to normal value at the time the patient was discharged.

Conclusion: Traumatic renal artery thrombosis is a rare occurrence with devastating consequences if any imaging is missed. Endovascular therapy plays a significant role in the treatment of renal artery thrombosis with a better prognosis.

References

Alabousi A, Mellnick VM, Patlas MN. Blunt Abdominal and Pelvic Trauma. In: Imaging in the ED. 2017. Available from: http://dx.doi.org/10.1007/springerreference_108869

Chong ST, Cherry-Bukowiec JR, Willatt JMG, Kielar AZ. Renal trauma: imaging evaluation and implications for clinical management. Abdom Radiol. 2016;41(8):1565–79. Available from: http://dx.doi.org/10.1007/s00261-016-0731-x

Markabawi D, Singh-Gambhir H. Acute renal infarction: A diagnostic challenge. Am J Emerg Med. 2018;36(7):1325.e1-1325.e2. Available from: http://dx.doi.org/10.1016/j.ajem.2018.04.018

Muller A, Rouvière O. Renal artery embolization—indications, technical approaches and outcomes. Nat Rev Nephrol. 2014;11(5):288–301. Available from: http://dx.doi.org/10.1038/nrneph.2014.231

Goldman SM, Sandler CM. Urogenital trauma: imaging upper GU trauma. Eur J Radiol. 2004;50(1):84–95. Available from: http://dx.doi.org/10.1016/j.ejrad.2003.11.018

Santucci RA, Wessells H, Bartsch G, Descotes J, Heyns CF, McAninch JW, et al. Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee. BJU Int. 2004;93(7):937–54. Available from: http://dx.doi.org/10.1111/j.1464-4096.2004.04820.x

Morey AF. Evaluation and Management of Renal Injuries: Consensus Statement of the Renal Trauma Subcommittee. J Urol. 2004;172(6 Part 1):2508.

Herschorn S, Radomski SB, Shoskes DA, Mahoney J, Hirshberg E, Klotz L. Evaluation and treatment of blunt renal trauma. J Urol. 1991;146(2):274–6.

Brown SL, Haas C, Dinchman KH, Elder JS, Spirnak JP. Radiologic Evaluation of Pediatric Blunt Renal Trauma in Patients with Microscopic Hematuria. World J Surg. 2001;25(12):1557–60. Available from: http://dx.doi.org/10.1007/s00268-001-0149-6

Anninos H, Sakellaris N, Manolis A. Indications for Renal Artery Stenting. Hosp Chronicles. 2009;4:67–74.


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